A Walsh Imaging: Online Order Form

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» ONLINE ORDER FORM

A Walsh Imaging clients may utilize this form to order radiographic accessories and supplies. If you're unsure of an item's price, you are welcome to contact us. In addition, clients have the ability of requesting delivery with their next pre-scheduled service in order to save money associated with delivery/shipping. Please note, we will contact you to arrange payment.

Please provide your information.

First Name:		Last Name:
Email:		Company:
Address:		Apt/Suite:
City:		State:
Country:		Postal Code:
Phone:		Fax (Optional):

Payment Information Please Select Method of Payment	Fulfillment Information Please Select Method of Fulfillment
Film Brand Please Select Film Brand	Film Type Please Select Film Type
Film Quantity Please Enter Quantity (Signify BOX or CASE) 14 x 17 IN 14 x 36 IN 11 x 14 IN 10 x 12 IN 8 x 10 IN 5 x 7 IN	35 x 43 CM 30 x 35 CM 24 x 30 CM 24 x 24 CM 18 x 43 CM 18 x 24 CM
Order Chemistry Please Enter Quantity Auto Dev Premixed (5 Gal) Auto Fix Premixed (5 Gal) Kodak RP Xomat Dev (10 Gal) Kodak RP Xomat Fixer (10 Gal)	Kodak MX Dev (10 Gal) Kodak MX Fixer (10 Gal) FR Dev (10 Gal) FR Fixer (10 Gal)
Order Supplies Please Enter Quantity Blue TPT Gowns 534 GD13 Large Gowns GD15 Capes EH 303 Table Paper EH 310 Chiro Paper Pillow Cases Tissue Paper Toilet Paper Fixer Hypo Test Kit Screen Cleaner I.D. Cards (blank) I.D. Printer L & R Markers	Full Lead Apron Half Lead Apron Lead Gloves 14x17 Envelopes 250 14x17 Envelopes 500 14x17 Mailers 10x12 Envelopes 10x12 Mailers Measuring Calipers Film Bin (5 Slot) Poly Bin (3 Slot) Safelight (Darkroom)

Order Other Products
Please Enter Your Desired Quantity and Products

  Quantity                         Product                          Quantity                      Product






Please write your comments below.
Please DO NOT Enter Payment Information

Please read prior to submitting:
• We will contact you regarding payment options.
• Emergency delivery: $30 NJ; and $35 NY, CT and PA.
• Delivery fees are per delivery order, not per item.
• Delivery w/ next scheduled service. ** FREE **

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